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Tumor, Node, Metastasis International Staging System for Lung Cancer

The Tumor, Node, Metastasis (TNM) staging system for lung cancer is an internationally accepted system used to characterize the extent of disease. The TNM system combines features of the tumor into disease stage groups that correlate with survival and are linked to recommendations for treatment.

Stage

TNM Descriptors

5-Year Survival Rate, %

Clinical Stage

Surgical-Pathologic Stage

IA

IB

IIA

IIB

IIB

IIIA

IIIB

IV

T1 N0 M0

T2 N0 M0

T1 N1 M0

T2 N1 M0

T3 N0 M0

T3 N1 M0

T1–2–3 N2 M0

T4 N0–1–2 M0

T1–2–3–4 N3 M0

Any T any N M1

61

38

34

24

22

9

13

7

3

1

67

57

55

39

38

25

23

<5

<3

<1

TUMOR (T) STATUS

T0 No evidence of a primary tumor

TX Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy

TIS Carcinoma in situ

T1 Tumor <3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than lobar bronchus (i.e., not in main bronchus)

T2 Tumor with any of following: >3 cm in greatest dimension; involves main bronchus, >2 cm distal to the carina; invades visceral pleura; associated with atelectasis or obstructive pneumonitis extending to hilum but does not involve entire lung

T3 Tumor of any size that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in main bronchus <2 cm distal to carina but without involvement of carina; or associated atelectasis or obstructive pneumonitis of entire lung

T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or tumor with a malignant pleural or pericardial effusiona, or with satellite tumor nodule(s) within the ipsilateral primary-tumor lobe of the lung.

a Most pleural effusions associated with lung cancer are due to tumor. However, in a few patients with multiple negative cytopathologic exams of a non-bloody, non-exudative pleural or pericardial effusion that clinical judgment dictates is not related to the tumor, the effusion should be excluded as a staging element and the patient’s disease staged as T1, T2, or T3.

b Separate metastatic pulmonary tumor nodule(s) in the ipsilateral nonprimary tumor lobe(s) of the lung are classified as M1.

References:

Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest. 1997 Jun;111(6):1710-7. [Medline]